Medicine’s struggle for inclusivity

Medicine, with its somewhat tarred history in the matter, has woken to the cause of inclusivity. Not too long ago, in the early twentieth century, the American Medical Association (AMA) orchestrated reforms requiring immigrant European doctors to pass rigorous qualification exams, which most American doctors themselves were highly unlikely to clear. Rather than concern about standards, it was largely cynical turf protection to squeeze out better-trained doctors the patients were turning to. So, how will its latest cause do? A passing fad, a hijacked platform, or a groundbreaking reform that will advance the field in leaps and bounds? Based on past precedent, if there is a draw, consider it a victory.

That there are now more females practicing medicine is “no thanks” to the open-mindedness of the field itself. The women and societal pressures broke down the barriers. If it were up to the many pioneer “fathers” of the field in this country, women would either be secretaries or nurses who did as they were told without giving any lip. Consistent with the norm in other fields, female doctors make less doing the same job as their male counterparts. It is telling that they form about 65 percent of the workforce in pediatrics (low-paying) but less than 10 percent in neurosurgery and about 5 percent in orthopedics. Nor has the greed and xenophobia that set up stumbling blocks for the European doctors setting up shop faded away. One particular specialty imposed restrictions upon its cohorts just north of the border, who had the same, if not better, standards of care. It was for the shortsighted motive of protecting the interests of a few of its own challenging members, who otherwise were unable to hold on to unhappy patients.

If we look at our professional bodies, conferences, departmental hierarchies, or any aspect of the organization, they are not reflective of the ground reality in gender or ethnicity. Let’s say there is an “expert panel” of four at a webinar, seminar, or working group of some importance. Chances are that the experts will be men. Or, they may thoughtfully include the token female. Chances are, but for her gender, she is “one of their own” and is constrained by many of the same beliefs, prejudices, stereotyping, and xenophobia. Chances are, she is one of several such, bandied for a politically correct appearance. Even in the fields where women are in the majority, the leadership and thought-makers remain predominantly men. Yes, there are the “firsts” and the “chair” somewhere, who can be pointed to as “proof of progress.”

Despite the recognition and some attempts at making the practice of medicine more egalitarian, the results, at best, are mixed. The fault may lie in how we have gone about doing it. Do the practitioners fairly represent the entire spectrum of the population with regard to ethnic diversity and gender? Is advancement and opportunity in the field largely on the basis of merit, or at least meaningfully progressing towards that goal? Alas, the answer is no.

While recognition of a problem is important in arriving at a solution, persisting with glossing over the recognized deficit leads nowhere. Therein lies one of the faults. For years now, we have witnessed a token number of females who stand out like a sore thumb amidst a crowd of men of various shapes, sizes, and ethnicities. While some specialties have become more egalitarian in this regard or simply been beaten into becoming so by the sheer numeric power of their female workforce, other specialties decidedly appear the preserve of an old boys club. As a face-saving measure, they may find the odd female who is helped along with the horde of their blue-eyed boys. A few among the many very competent women succeed in making their way to the top by sheer grit and the odd stroke of good luck. The overall picture, therefore, has remained unchanged.

Human nature and prejudices contribute to this dilemma. Most are inclined to have a more favorable view of someone who looks and speaks like themselves. Many also gravitate towards being part of a group or clique, that tends to promote its own and shun outsiders. Such tribalism is particularly obvious in academia and can be almost amusing to witness at conferences. The smaller the subsection, the more apparent are the various factions.

To a degree, the cause of more equal representation may also be undermined by some women themselves. Being part of the same culture, they are not impervious to xenophobia or cultural, racial, or religious prejudices. Then, there is the known phenomenon of women who reach the top and pull the ladder behind them. Rather than helping or mentoring, they undermine the younger and less experienced. Or, use their acquired power to satisfy past petty grudges against other women they may perceive as a threat. For some, it is simply not their goal in life to uplift others. Some use the disparity to make hay while the sun shines. They loudly protest the gender gap and exploit the gender and financial disparity statistics in the guise of speaking up as a representative while actually milking the issue for all it is worth for their benefit. It is a small wonder that female representation at the forefront and leadership doesn’t seem to grow beyond the usual suspects.

The present state of affairs invites a rethink. How do we level the playing field for all? Platitudes, feel-good seminars, courses, and tokenism won’t do. We must devise a strategy that is inclusive across the board. It will make medicine better.

Shah-Naz H. Khan is a neurosurgeon.


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